7259 Optimizing the Aldosterone-to-Renin Ratio Cut-off for Screening Primary Aldosteronism Based on Cardiovascular Risk: A Collaborative Study

Abstract Disclosure: J. Hu: None. J. Yang: None. Objectives: Aldosterone-to-renin ratio (ARR) based screening is the first step in the diagnosis of primary aldosteronism (PA). However, the guideline-recommended ARR cut-off covers a wide range, from the equivalent of 1.3 to 4.9 ng·dl-[1]/mIU·l-[1]. We aimed to optimize the ARR cut-off for PA screening based on the risk of cardiovascular diseases (CVD). Methods: Longitudinally, we included hypertensive participants from the Framingham Offspring Study (FOS) who attended the sixth examination cycle and followed up until 2014. At baseline (1995-1998), we used circulating concentrations of aldosterone and renin to calculate ARR (unit: ng·dl-[1]/mIU·l-[1]) among 1,433 subjects who were free of CVD. We used spline regression to calculate the ARR threshold based on the incident CVD. We used cross-sectional data from the Chongqing Primary Aldosteronism Study (CONPASS) to explore whether the ARR cut-off selected from FOS is applicable to PA screening. Results: In FOS, CVD risk increased with an increasing ARR until a peak of ARR 1.0, followed by a plateau in CVD risk (hazard ratio 1.49, 95%CI 1.19-1.86). In CONPASS, when compared to essential hypertension with ARR<1.0, PA with ARR≥1.0 carried a higher CVD risk (odds ratio 2.24, 95%CI 1.41-3.55), while essential hypertension with ARR≥1.0 had an unchanged CVD risk (1.02, 0.62-1.68). Setting ARR cut-off at 2.4∼4.9, 10%∼30% of PA subjects would be unrecognized although they carried a 2.45∼2.58-fold higher CVD risk than essential hypertension. Conclusions: The CVD risk-based optimal ARR cut-off is 1.0 ng·dl-[1]/mIU·l-[1] for PA screening. The current guideline-recommended ARR cut-off may miss patients with PA and high CVD risk. Presentation: 6/3/2024